US20070286817A1 - Treating cystic fibrosis with antibiotics via a swirler delivery - Google Patents
Treating cystic fibrosis with antibiotics via a swirler delivery Download PDFInfo
- Publication number
- US20070286817A1 US20070286817A1 US11/810,182 US81018207A US2007286817A1 US 20070286817 A1 US20070286817 A1 US 20070286817A1 US 81018207 A US81018207 A US 81018207A US 2007286817 A1 US2007286817 A1 US 2007286817A1
- Authority
- US
- United States
- Prior art keywords
- injection
- antibiotic
- aerosol
- microns
- dextrose
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- 239000003242 anti bacterial agent Substances 0.000 title claims abstract description 17
- 229940088710 antibiotic agent Drugs 0.000 title claims description 8
- 201000003883 Cystic fibrosis Diseases 0.000 title claims description 5
- 239000000443 aerosol Substances 0.000 claims abstract description 35
- 230000003115 biocidal effect Effects 0.000 claims abstract description 27
- 238000000034 method Methods 0.000 claims abstract description 16
- 239000000203 mixture Substances 0.000 claims abstract description 12
- 239000003814 drug Substances 0.000 claims abstract description 10
- 229940079593 drug Drugs 0.000 claims abstract description 10
- 208000023504 respiratory system disease Diseases 0.000 claims abstract description 8
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims description 26
- 239000002245 particle Substances 0.000 claims description 20
- 239000007924 injection Substances 0.000 claims description 19
- 238000002347 injection Methods 0.000 claims description 19
- 229940061267 tygacil Drugs 0.000 claims description 15
- 239000003085 diluting agent Substances 0.000 claims description 12
- WQZGKKKJIJFFOK-GASJEMHNSA-N Glucose Natural products OC[C@H]1OC(O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-GASJEMHNSA-N 0.000 claims description 11
- 239000008121 dextrose Substances 0.000 claims description 11
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Chemical compound O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 claims description 11
- 238000012377 drug delivery Methods 0.000 claims description 9
- 239000011780 sodium chloride Substances 0.000 claims description 9
- WCUXLLCKKVVCTQ-UHFFFAOYSA-M Potassium chloride Chemical compound [Cl-].[K+] WCUXLLCKKVVCTQ-UHFFFAOYSA-M 0.000 claims description 8
- 239000008227 sterile water for injection Substances 0.000 claims description 8
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 claims description 5
- 229910052708 sodium Inorganic materials 0.000 claims description 5
- 239000011734 sodium Substances 0.000 claims description 5
- 229960002292 piperacillin Drugs 0.000 claims description 4
- 239000001103 potassium chloride Substances 0.000 claims description 4
- 235000011164 potassium chloride Nutrition 0.000 claims description 4
- TUPFOYXHAYOHIB-YCAIQWGJSA-M sodium;(2s,5r,6r)-6-[[(2r)-2-[(4-ethyl-2,3-dioxopiperazine-1-carbonyl)amino]-2-phenylacetyl]amino]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate;(2s,3s,5r)-3-methyl-4,4,7-trioxo-3-(triazol-1-ylmethyl)-4$l^{6}-thia-1-azabicyclo[3.2.0]h Chemical compound [Na+].C([C@]1(C)S([C@H]2N(C(C2)=O)[C@H]1C(O)=O)(=O)=O)N1C=CN=N1.O=C1C(=O)N(CC)CCN1C(=O)N[C@H](C=1C=CC=CC=1)C(=O)N[C@@H]1C(=O)N2[C@@H](C([O-])=O)C(C)(C)S[C@@H]21 TUPFOYXHAYOHIB-YCAIQWGJSA-M 0.000 claims description 4
- 229960003865 tazobactam Drugs 0.000 claims description 4
- LPQZKKCYTLCDGQ-WEDXCCLWSA-N tazobactam Chemical compound C([C@]1(C)S([C@H]2N(C(C2)=O)[C@H]1C(O)=O)(=O)=O)N1C=CN=N1 LPQZKKCYTLCDGQ-WEDXCCLWSA-N 0.000 claims description 4
- 229940104666 zosyn Drugs 0.000 claims description 4
- FPZLLRFZJZRHSY-HJYUBDRYSA-N tigecycline Chemical compound C([C@H]1C2)C3=C(N(C)C)C=C(NC(=O)CNC(C)(C)C)C(O)=C3C(=O)C1=C(O)[C@@]1(O)[C@@H]2[C@H](N(C)C)C(O)=C(C(N)=O)C1=O FPZLLRFZJZRHSY-HJYUBDRYSA-N 0.000 claims description 3
- 241000124008 Mammalia Species 0.000 claims description 2
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 claims description 2
- 208000035475 disorder Diseases 0.000 claims description 2
- 239000008263 liquid aerosol Substances 0.000 claims 1
- IVBHGBMCVLDMKU-GXNBUGAJSA-N piperacillin Chemical compound O=C1C(=O)N(CC)CCN1C(=O)N[C@H](C=1C=CC=CC=1)C(=O)N[C@@H]1C(=O)N2[C@@H](C(O)=O)C(C)(C)S[C@@H]21 IVBHGBMCVLDMKU-GXNBUGAJSA-N 0.000 claims 1
- 210000004072 lung Anatomy 0.000 abstract description 12
- SOVUOXKZCCAWOJ-HJYUBDRYSA-N (4s,4as,5ar,12ar)-9-[[2-(tert-butylamino)acetyl]amino]-4,7-bis(dimethylamino)-1,10,11,12a-tetrahydroxy-3,12-dioxo-4a,5,5a,6-tetrahydro-4h-tetracene-2-carboxamide Chemical compound C1C2=C(N(C)C)C=C(NC(=O)CNC(C)(C)C)C(O)=C2C(O)=C2[C@@H]1C[C@H]1[C@H](N(C)C)C(=O)C(C(N)=O)=C(O)[C@@]1(O)C2=O SOVUOXKZCCAWOJ-HJYUBDRYSA-N 0.000 description 23
- 229960004089 tigecycline Drugs 0.000 description 10
- 239000007789 gas Substances 0.000 description 8
- WCMIIGXFCMNQDS-IDYPWDAWSA-M piperacillin sodium Chemical compound [Na+].O=C1C(=O)N(CC)CCN1C(=O)N[C@H](C=1C=CC=CC=1)C(=O)N[C@@H]1C(=O)N2[C@@H](C([O-])=O)C(C)(C)S[C@@H]21 WCMIIGXFCMNQDS-IDYPWDAWSA-M 0.000 description 8
- 239000000126 substance Substances 0.000 description 8
- 150000001875 compounds Chemical class 0.000 description 7
- HEMHJVSKTPXQMS-UHFFFAOYSA-M Sodium hydroxide Chemical compound [OH-].[Na+] HEMHJVSKTPXQMS-UHFFFAOYSA-M 0.000 description 6
- 239000000047 product Substances 0.000 description 6
- 239000007788 liquid Substances 0.000 description 5
- 239000000243 solution Substances 0.000 description 5
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 description 4
- VEXZGXHMUGYJMC-UHFFFAOYSA-N Hydrochloric acid Chemical compound Cl VEXZGXHMUGYJMC-UHFFFAOYSA-N 0.000 description 4
- 239000008176 lyophilized powder Substances 0.000 description 4
- 229960005264 piperacillin sodium Drugs 0.000 description 4
- NDIURPSCHWTXDC-UHFFFAOYSA-N 2-(4,5-dimethoxy-2-nitrophenyl)acetohydrazide Chemical compound COC1=CC(CC(=O)NN)=C([N+]([O-])=O)C=C1OC NDIURPSCHWTXDC-UHFFFAOYSA-N 0.000 description 3
- 239000008156 Ringer's lactate solution Substances 0.000 description 3
- 230000000694 effects Effects 0.000 description 3
- 238000001990 intravenous administration Methods 0.000 description 3
- 239000013028 medium composition Substances 0.000 description 3
- 238000010979 pH adjustment Methods 0.000 description 3
- 230000035515 penetration Effects 0.000 description 3
- 239000000843 powder Substances 0.000 description 3
- 229960000373 tazobactam sodium Drugs 0.000 description 3
- 238000012360 testing method Methods 0.000 description 3
- 239000004098 Tetracycline Substances 0.000 description 2
- WCMIIGXFCMNQDS-KIUVCKFDSA-M [H][C@]12SC(C)(C)[C@H](C(=O)O[Na])N1C(=O)C2NC(=O)C(NC(=O)N1CCN(CC)C(=O)C1=O)C1=CC=CC=C1 Chemical compound [H][C@]12SC(C)(C)[C@H](C(=O)O[Na])N1C(=O)C2NC(=O)C(NC(=O)N1CCN(CC)C(=O)C1=O)C1=CC=CC=C1 WCMIIGXFCMNQDS-KIUVCKFDSA-M 0.000 description 2
- 230000000844 anti-bacterial effect Effects 0.000 description 2
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 2
- 238000001802 infusion Methods 0.000 description 2
- 239000003595 mist Substances 0.000 description 2
- 229910052757 nitrogen Inorganic materials 0.000 description 2
- 239000001301 oxygen Substances 0.000 description 2
- 229910052760 oxygen Inorganic materials 0.000 description 2
- 239000008354 sodium chloride injection Substances 0.000 description 2
- 239000003381 stabilizer Substances 0.000 description 2
- 235000019364 tetracycline Nutrition 0.000 description 2
- 150000003522 tetracyclines Chemical class 0.000 description 2
- GUBGYTABKSRVRQ-UHFFFAOYSA-N 2-(hydroxymethyl)-6-[4,5,6-trihydroxy-2-(hydroxymethyl)oxan-3-yl]oxyoxane-3,4,5-triol Chemical compound OCC1OC(OC2C(O)C(O)C(O)OC2CO)C(O)C(O)C1O GUBGYTABKSRVRQ-UHFFFAOYSA-N 0.000 description 1
- WSVLPVUVIUVCRA-KPKNDVKVSA-N Alpha-lactose monohydrate Chemical compound O.O[C@@H]1[C@@H](O)[C@@H](O)[C@@H](CO)O[C@H]1O[C@@H]1[C@@H](CO)O[C@H](O)[C@H](O)[C@H]1O WSVLPVUVIUVCRA-KPKNDVKVSA-N 0.000 description 1
- 229940123930 Lactamase inhibitor Drugs 0.000 description 1
- 208000019693 Lung disease Diseases 0.000 description 1
- 125000000738 acetamido group Chemical group [H]C([H])([H])C(=O)N([H])[*] 0.000 description 1
- 239000004480 active ingredient Substances 0.000 description 1
- XAGFODPZIPBFFR-UHFFFAOYSA-N aluminium Chemical compound [Al] XAGFODPZIPBFFR-UHFFFAOYSA-N 0.000 description 1
- 229910052782 aluminium Inorganic materials 0.000 description 1
- 229960005475 antiinfective agent Drugs 0.000 description 1
- 239000004599 antimicrobial Substances 0.000 description 1
- 208000006673 asthma Diseases 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 238000004166 bioassay Methods 0.000 description 1
- 239000008364 bulk solution Substances 0.000 description 1
- 229920005549 butyl rubber Polymers 0.000 description 1
- 239000002775 capsule Substances 0.000 description 1
- 239000013066 combination product Substances 0.000 description 1
- 229940127555 combination product Drugs 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 239000008355 dextrose injection Substances 0.000 description 1
- 239000002552 dosage form Substances 0.000 description 1
- 239000002158 endotoxin Substances 0.000 description 1
- 238000009472 formulation Methods 0.000 description 1
- 238000004108 freeze drying Methods 0.000 description 1
- 239000011521 glass Substances 0.000 description 1
- 239000004615 ingredient Substances 0.000 description 1
- 238000010255 intramuscular injection Methods 0.000 description 1
- 238000007912 intraperitoneal administration Methods 0.000 description 1
- 238000007913 intrathecal administration Methods 0.000 description 1
- 238000010253 intravenous injection Methods 0.000 description 1
- 229960001021 lactose monohydrate Drugs 0.000 description 1
- 239000002502 liposome Substances 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 230000001404 mediated effect Effects 0.000 description 1
- 150000004682 monohydrates Chemical class 0.000 description 1
- 239000006199 nebulizer Substances 0.000 description 1
- 244000052769 pathogen Species 0.000 description 1
- 150000002960 penicillins Chemical class 0.000 description 1
- 230000003389 potentiating effect Effects 0.000 description 1
- 210000003705 ribosome Anatomy 0.000 description 1
- 238000001228 spectrum Methods 0.000 description 1
- FKENQMMABCRJMK-RITPCOANSA-N sulbactam Chemical compound O=S1(=O)C(C)(C)[C@H](C(O)=O)N2C(=O)C[C@H]21 FKENQMMABCRJMK-RITPCOANSA-N 0.000 description 1
- 239000003826 tablet Substances 0.000 description 1
- 229960002180 tetracycline Drugs 0.000 description 1
- 229930101283 tetracycline Natural products 0.000 description 1
- 229940040944 tetracyclines Drugs 0.000 description 1
- 230000000699 topical effect Effects 0.000 description 1
- 239000003981 vehicle Substances 0.000 description 1
- 239000008215 water for injection Substances 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/007—Pulmonary tract; Aromatherapy
- A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
- A61K9/0078—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a nebulizer such as a jet nebulizer, ultrasonic nebulizer, e.g. in the form of aqueous drug solutions or dispersions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
- A61K31/425—Thiazoles
- A61K31/429—Thiazoles condensed with heterocyclic ring systems
- A61K31/43—Compounds containing 4-thia-1-azabicyclo [3.2.0] heptane ring systems, i.e. compounds containing a ring system of the formula, e.g. penicillins, penems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/54—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame
- A61K31/542—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame ortho- or peri-condensed with heterocyclic ring systems
- A61K31/545—Compounds containing 5-thia-1-azabicyclo [4.2.0] octane ring systems, i.e. compounds containing a ring system of the formula:, e.g. cephalosporins, cefaclor, or cephalexine
Definitions
- the present invention is directed to a method of treating respiratory disorders by delivering an antibiotic aerosol formulation to the lung alveoli.
- Nebulizers and other aerosol devices have been used to deliver drugs for asthma patients. However, not all these devices deliver droplets that are small enough to provide deep lung penetration, which may be beneficial in delivering certain drugs, such as antibiotics. Some aerosol devices are capable of delivering the smaller droplet sizes needed for deep lung penetration.
- SWIRLER® aerosol drug delivery system which is described at amici-inc.com, and in U.S. Pat. Nos. 5,603,314, 5,630,409, 5,611,332 and 6,230,703, which patents are incorporated by reference herein.
- the SWIRLER® aerosol drug delivery system is an aerosol inhalation device that provides an aerosol mist to a patient.
- This device includes a nebulizer having a liquid reservoir containing the liquid to be inhaled, a gas inlet for receiving pressurized gas, and an aerosol outlet.
- An important feature of the device is a gas swirling or flow control means which creates a swirling action to the gas forming the aerosol; this produces a greater shear force and smaller particle sizes.
- the swirling gas creates a vacuum as it exits the outlet and this vacuum draws liquid form the reservoir, producing an aerosol.
- the device is capable of producing aerosol particles less than one micrometer in size.
- ZOSYN® is an injectable antibacterial combination product consisting of the semi synthetic antibiotic piperacillin sodium and the (beta)-lactamase inhibitor tazobactam sodium for intravenous administration.
- the product is disclosed in U.S. Pat. Nos. 4,562,073, 4,477,452, 4,534,977, and 6,207,661.
- Piperacillin sodium is derived from D( ⁇ )-(alpha)-aminobenzyl-penicillin.
- the chemical name of piperacillin sodium is sodium (2S,5R,6 R)-6-[(R)-2-(4-ethyl-2,3-dioxo-1-piperazine-carboxamido)-2-phenylacetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate.
- the chemical formula is C 23 H 26 N 5 NaO 7 S and the molecular weight is 539.5.
- the product is disclosed in U.S. Pat. No. 4,562,073.
- Tazobactam sodium a derivative of the penicillin nucleus, is a penicillanic acid sulfone. Its chemical name is sodium (2S,3 S,5 R)-3-methyl-7-oxo-3-(1H-1,2,3-triazol-1-ylmethyl)-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate-4,4-dioxide. The chemical formula is C 10 H 11 N 4 NaO 5 S and the molecular weight is 322.3. The product is disclosed in U.S. Pat. No. 4,958,020.
- TYGACIL® is a first in class glycylcycline antibacterial disclosed in U.S. Pat. No. 5,494,903.
- the chemical name of tigecycline is (4S,4aS,5aR,12aS)-9-[2-(tert-butylamino)acetamido]-4,7-bis(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a-tetrahydroxy-1,1′-dioxo-2-naphthacenecarboxamide.
- the empirical formula is C 29 H 39 N 5 O 8 and the molecular weight is 585.65.
- Tigecycline has an expanded spectrum of activity against gram positives, gram negatives, anaerobes, and atypicals including resistant pathogens, and allows for flat dosing.
- the product is disclosed in U.S. Pat. Nos. 5,494,903, 5,299,900, and 5,284,963.
- the present invention comprises a method of treating a respiratory disorder comprising administering an antibiotic drug suitable for treating said disorder to a mammal in need thereof via a drug delivery system such as the SWIRLER aerosol drug delivery system, which produces an aerosol composition of said antibiotic drug in which the particle size of the antibiotic composition droplets is small enough to provide deep lung penetration.
- a drug delivery system such as the SWIRLER aerosol drug delivery system
- the antibiotic droplets in the aerosol are about 1-3 microns or less, more preferably 1.1 microns or less.
- the antibiotic aerosol typically will comprise an antibiotic and a diluent.
- the diluent can be, for example, sterile water for Injection, 0.9% sodium chloride for injection, 5% dextrose for injection, 5% dextrose and 0.9% sodium chloride for injection, 5% dextrose in lactated Ringers for injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride for injection or lactated Ringers for injection.
- a liquid composition comprising the drug and the diluent is placed in the reservoir of the SWIRLER® aerosol drug delivery system, which is connected to a source of pressurized gas, which gas is not reactive with the liquid composition.
- the device is designed to impart a swirling action to the gas and to create a fine mist of aerosol droplets which can be smaller than one micrometer.
- Antibiotics of the present invention include anti-infective agents known in the art, such as those found in the current Physician's Desk Reference published by Medical Economics Company (www.pdr.net) and hereby incorporated by reference, including but are not limited to ZOSYN®, Piperacillin, Tazobactam, and TYGACIL®.
- the antibiotic can be administered alone or in combination with other antibiotics.
- at least one of the antibiotics is administered in an aerosol medium composition.
- Additional antibiotics may be administered orally, or by intralesional, intraperitoneal, intramuscular or intravenous injection; infusion; liposome-mediated delivery; topical, nasal, anal, vaginal, sublingual, uretheral, transdermal, intrathecal, ocular or optic delivery.
- a compound of the invention is in the form of a unit dose. Suitable unit dose forms include tablets, capsules and powders in sachets or vials. Such unit dose forms may contain from 0.1 to 300 mg of a compound of the invention and preferably from 2 to 100 mg. Still further preferred unit dosage forms contain 5 to 50 mg of a compound of the present invention.
- the effective amount will be known to one of skill in the art; it will also be dependent upon the form of the compound.
- One of skill in the art could routinely perform empirical activity tests to determine the bioactivity of the compound in bioassays and thus determine what dosage to administer.
- the aerosol medium composition may comprise diluents such as sterile water for injection, 0.9% sodium chloride for injection, 5% dextrose for injection, 5% dextrose and 0.9% sodium chloride for injection, 5% dextrose in lactated Ringers for injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride for injection or lactated Ringers injection.
- diluents such as sterile water for injection, 0.9% sodium chloride for injection, 5% dextrose for injection, 5% dextrose and 0.9% sodium chloride for injection, 5% dextrose in lactated Ringers for injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride for injection or lactated Ringers injection.
- the antibiotic is suspended in the aerosol medium at a particle size range that will meet the subvisible particulate testing acceptance criteria as per USP 788 viz. not more than 600 particles ⁇ 25 microns and not more than 6000 particles ⁇ 10 microns.
- the invention comprises a method of treating respiratory disorders using the SWIRLER drug delivery system to deliver an aerosol containing an antibiotic compound and to reduce the particle size of at least about 95% of the antibiotic droplets in the aerosol to about 1-3 microns or less, thereby allowing the antibiotic aerosol to reach the alveoli of the lung.
- at least about 95% of the antibiotic particles is delivered at a particle size of less than 1.1 microns.
- This method is useful for treating a respiratory disorder such as, but not limited to, cystic fibrosis.
- Tygacil® 2 nd Generation product was used to conduct the study. Sterile Water for injection and 0.9% Normal Saline were used at diluents. Tygacil® is a sterile, lyophilized powder for intravenous infusion, containing 53 mg of the Tigecycline active ingredient. Tygacil® additionally contains lactose monohydrate as a diluent/stabilizer and hydrochloric acid and/or sodium hydroxide (as needed) for pH adjustment. The product is supplied in a single dose; Type I, clear, glass vial, sealed under a blanket of nitrogen with a gray butyl rubber stopper and a snap-off aluminum crimp seal.
- Tigecycline for Injection is an orange powder or cake.
- Tygacil® was reconstituted using 100 ml of 0.9% Sodium Chloride (Normal Saline) or Sterile Water for Injection USP.
- the Tigecycline powder was allowed to dissolve in the diluents. A clear yellow to orange solution was obtained.
- the solution was then transferred into the SWIRLER® device.
- Oxygen was supplied to the SWIRLER® via an NG tube to aerosolize the solution.
- An oxygen air pressure regulator was used to set the air pressure to 15 CFM.
- a Malvern MXS, S/N 6196 was used to measure the particle size of the droplets. Results show a high percentage (90%) of the particles are less than 1.1 micron which is the desired size for deep lung delivery. Data are reported in Table 2 below:
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- Health & Medical Sciences (AREA)
- Chemical & Material Sciences (AREA)
- Medicinal Chemistry (AREA)
- Pharmacology & Pharmacy (AREA)
- Epidemiology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Dispersion Chemistry (AREA)
- Otolaryngology (AREA)
- Pulmonology (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Medicinal Preparation (AREA)
Abstract
The present invention is directed to a method of treating respiratory disorders by delivering an aerosol composition of an antibiotic drug to the lung alveoli.
Description
- This application claims priority from co-pending U.S. provisional application No. 60/811,671 filed on Jun. 7, 2006.
- The present invention is directed to a method of treating respiratory disorders by delivering an antibiotic aerosol formulation to the lung alveoli.
- Nebulizers and other aerosol devices have been used to deliver drugs for asthma patients. However, not all these devices deliver droplets that are small enough to provide deep lung penetration, which may be beneficial in delivering certain drugs, such as antibiotics. Some aerosol devices are capable of delivering the smaller droplet sizes needed for deep lung penetration. One commercially available example is the SWIRLER® aerosol drug delivery system which is described at amici-inc.com, and in U.S. Pat. Nos. 5,603,314, 5,630,409, 5,611,332 and 6,230,703, which patents are incorporated by reference herein.
- As described in greater detail in the aforementioned patents, the SWIRLER® aerosol drug delivery system is an aerosol inhalation device that provides an aerosol mist to a patient. This device includes a nebulizer having a liquid reservoir containing the liquid to be inhaled, a gas inlet for receiving pressurized gas, and an aerosol outlet. An important feature of the device is a gas swirling or flow control means which creates a swirling action to the gas forming the aerosol; this produces a greater shear force and smaller particle sizes. The swirling gas creates a vacuum as it exits the outlet and this vacuum draws liquid form the reservoir, producing an aerosol. The device is capable of producing aerosol particles less than one micrometer in size.
- ZOSYN® is an injectable antibacterial combination product consisting of the semi synthetic antibiotic piperacillin sodium and the (beta)-lactamase inhibitor tazobactam sodium for intravenous administration. The product is disclosed in U.S. Pat. Nos. 4,562,073, 4,477,452, 4,534,977, and 6,207,661.
- Piperacillin sodium is derived from D(−)-(alpha)-aminobenzyl-penicillin. The chemical name of piperacillin sodium is sodium (2S,5R,6 R)-6-[(R)-2-(4-ethyl-2,3-dioxo-1-piperazine-carboxamido)-2-phenylacetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate. The chemical formula is C23H26N5NaO7S and the molecular weight is 539.5. The product is disclosed in U.S. Pat. No. 4,562,073.
- The chemical structure of piperacillin sodium is:
- Tazobactam sodium, a derivative of the penicillin nucleus, is a penicillanic acid sulfone. Its chemical name is sodium (2S,3 S,5 R)-3-methyl-7-oxo-3-(1H-1,2,3-triazol-1-ylmethyl)-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate-4,4-dioxide. The chemical formula is C10H11N4NaO5 S and the molecular weight is 322.3. The product is disclosed in U.S. Pat. No. 4,958,020.
- The chemical structure of tazobactam sodium is:
- TYGACIL® (tigecycline) is a first in class glycylcycline antibacterial disclosed in U.S. Pat. No. 5,494,903. The chemical name of tigecycline is (4S,4aS,5aR,12aS)-9-[2-(tert-butylamino)acetamido]-4,7-bis(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a-tetrahydroxy-1,1′-dioxo-2-naphthacenecarboxamide. The empirical formula is C29H39N5O8 and the molecular weight is 585.65. It is a 9-tert-butyl-glycylamido derivative of monocycline which exhibits antibiotic activity typical of tetracyclines, but has more potent activity against tetracycline-resistant organisms having efflux and ribosomal protection mechanisms of resistance. Tigecycline has an expanded spectrum of activity against gram positives, gram negatives, anaerobes, and atypicals including resistant pathogens, and allows for flat dosing. The product is disclosed in U.S. Pat. Nos. 5,494,903, 5,299,900, and 5,284,963.
- The following represents the chemical structure of tigecycline:
- There exists a need to deliver these and other antibiotics to patients via aerosol directly to the lungs to provide another option in the treatment of lung disorders, for example, cystic fibrosis.
- These and other embodiments are provided for by the invention disclosed and claimed herein.
- The present invention comprises a method of treating a respiratory disorder comprising administering an antibiotic drug suitable for treating said disorder to a mammal in need thereof via a drug delivery system such as the SWIRLER aerosol drug delivery system, which produces an aerosol composition of said antibiotic drug in which the particle size of the antibiotic composition droplets is small enough to provide deep lung penetration. Preferably, at least about 90%, such as 95% or more, of the antibiotic droplets in the aerosol are about 1-3 microns or less, more preferably 1.1 microns or less.
- For delivery, the antibiotic aerosol typically will comprise an antibiotic and a diluent. The diluent can be, for example, sterile water for Injection, 0.9% sodium chloride for injection, 5% dextrose for injection, 5% dextrose and 0.9% sodium chloride for injection, 5% dextrose in lactated Ringers for injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride for injection or lactated Ringers for injection.
- In the practice of this invention, a liquid composition comprising the drug and the diluent is placed in the reservoir of the SWIRLER® aerosol drug delivery system, which is connected to a source of pressurized gas, which gas is not reactive with the liquid composition. The device is designed to impart a swirling action to the gas and to create a fine mist of aerosol droplets which can be smaller than one micrometer.
- Antibiotics of the present invention include anti-infective agents known in the art, such as those found in the current Physician's Desk Reference published by Medical Economics Company (www.pdr.net) and hereby incorporated by reference, including but are not limited to ZOSYN®, Piperacillin, Tazobactam, and TYGACIL®. The antibiotic can be administered alone or in combination with other antibiotics. In accordance with the invention, at least one of the antibiotics is administered in an aerosol medium composition. Additional antibiotics may be administered orally, or by intralesional, intraperitoneal, intramuscular or intravenous injection; infusion; liposome-mediated delivery; topical, nasal, anal, vaginal, sublingual, uretheral, transdermal, intrathecal, ocular or optic delivery. In order to obtain consistency in providing the compound of this invention it is preferred that a compound of the invention is in the form of a unit dose. Suitable unit dose forms include tablets, capsules and powders in sachets or vials. Such unit dose forms may contain from 0.1 to 300 mg of a compound of the invention and preferably from 2 to 100 mg. Still further preferred unit dosage forms contain 5 to 50 mg of a compound of the present invention. The effective amount will be known to one of skill in the art; it will also be dependent upon the form of the compound. One of skill in the art could routinely perform empirical activity tests to determine the bioactivity of the compound in bioassays and thus determine what dosage to administer.
- In one embodiment of the present invention, there is provided a method of delivering an aerosol medium composition containing an antibiotic via the SWIRLER drug delivery system. The aerosol medium composition may comprise diluents such as sterile water for injection, 0.9% sodium chloride for injection, 5% dextrose for injection, 5% dextrose and 0.9% sodium chloride for injection, 5% dextrose in lactated Ringers for injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride for injection or lactated Ringers injection.
- In one embodiment, the antibiotic is suspended in the aerosol medium at a particle size range that will meet the subvisible particulate testing acceptance criteria as per USP 788 viz. not more than 600 particles ≧25 microns and not more than 6000 particles ≧10 microns.
- In one embodiment, the invention comprises a method of treating respiratory disorders using the SWIRLER drug delivery system to deliver an aerosol containing an antibiotic compound and to reduce the particle size of at least about 95% of the antibiotic droplets in the aerosol to about 1-3 microns or less, thereby allowing the antibiotic aerosol to reach the alveoli of the lung. In another embodiment, at least about 95% of the antibiotic particles is delivered at a particle size of less than 1.1 microns.
- This method is useful for treating a respiratory disorder such as, but not limited to, cystic fibrosis.
- When used herein, the term “about” shall generally mean within 20 percent.
- It will be understood by those with skill in the art that the invention may be performed within a wide and equivalent range of conditions, parameters and the like, without affecting the spirit or scope of the invention or any embodiment thereof.
- A drug such as Piperacillin (2 g-4 g lyophilized powder per vial), Tazobactam (0.25 g-0.50 g lyophilized powder per vial), Tygacil (50 mg lyophilized powder per 5 mL vial), or ZOSYN® (2-4 g piperacillin plus 250-500 mg tazobactam), and at least one intravenous diluent, for example but not limited to sterile water for injection, 0.9% sodium chloride injection, 5% dextrose injection, 5% dextrose and 0.9% sodium chloride injection, 5% dextrose in Lactated Ringers injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride injection or lactated Ringers injection may be administered using a SWIRLER drug delivery system, or an equivalent aerosol delivery system, at a particle size of 95% particles ranging from about 1 to about 3 microns and preferably less than about 1.1 microns to ensure deep lung delivery to the alveolar region of the lungs. Those skilled in the art will readily be capable of determining whether a delivery system is able to provide the aerosol particle sizes of the present invention.
- The following examples are presented to illustrate certain embodiments of the present invention, but should not be construed as limiting the scope of this invention.
- The commercial Tygacil® 2nd Generation product was used to conduct the study. Sterile Water for injection and 0.9% Normal Saline were used at diluents. Tygacil® is a sterile, lyophilized powder for intravenous infusion, containing 53 mg of the Tigecycline active ingredient. Tygacil® additionally contains lactose monohydrate as a diluent/stabilizer and hydrochloric acid and/or sodium hydroxide (as needed) for pH adjustment. The product is supplied in a single dose; Type I, clear, glass vial, sealed under a blanket of nitrogen with a gray butyl rubber stopper and a snap-off aluminum crimp seal.
-
-
TABLE 1 Quantitative Composition for Tygacil ® Reference to Ingredient Standards Function Quantity per Vial Tigecyclinea In-House Active 53 mg Monograph Lactose NF/Ph. Eur.b Diluent/ 106 mg Monohydrate Stabilizer Hydrochloric Acid NF/Ph. Eur. pH Adjustment Q.S. to adjust pH Sodium Hydroxide NF/Ph. Eur. pH Adjustment Q.S. to adjust pH Water for Injectionc USP/Ph. Eur. Vehicle —c Nitrogend NF/Ph. Eur. Blanket Q.S. to Headspace aA 6% overage is included to compensate for the non-withdrawable amount of solution after constitution, i.e. solution adhering to the inside wall of the vial. bAn in-house specification for bacterial endotoxins test is also applied. cRemoved during lyophilization. dUsed for sparging and blanketing the bulk solution and as inert cover in the filled vials. - Prior to reconstitution, Tigecycline for Injection is an orange powder or cake. One (1) vial of Tygacil® was reconstituted using 100 ml of 0.9% Sodium Chloride (Normal Saline) or Sterile Water for Injection USP. The Tigecycline powder was allowed to dissolve in the diluents. A clear yellow to orange solution was obtained. The solution was then transferred into the SWIRLER® device. Oxygen was supplied to the SWIRLER® via an NG tube to aerosolize the solution. An oxygen air pressure regulator was used to set the air pressure to 15 CFM. A Malvern MXS, S/N 6196 was used to measure the particle size of the droplets. Results show a high percentage (90%) of the particles are less than 1.1 micron which is the desired size for deep lung delivery. Data are reported in Table 2 below:
-
TABLE 2 PARTICLE SIZE DISTRIBUTION OF TYGACIL ® RECONSTITUTED WITH NORMAL SALINE OR STERILE WATER FOR INJECTION AND ADMINISTERED THROUGH A SWIRLER ® FOR DEEP LUNG DELIVERY Obscuration D 10 D 50 D 90 (%) (um) (um) (um) Water Trial 1 32.7 0.38 0.58 0.93 Trial 2 32.7 0.41 0.61 0.99 Trial 3 36.7 0.37 0.56 0.88 0.9% NaCl Trial 1 28.1 0.42 0.62 1.02 Trial 2 31 0.4 0.6 0.98 Trial 3 33.9 0.4 0.6 0.98 0.9% NaCl + TYG* Trial 1 27.8 0.41 0.61 1 Trial 2 16.6 0.39 0.59 0.96 Trial 3 14.9 0.38 0.58 0.94 0.9% NaCl + TYG** Trial 1 28 0.45 0.65 1.11 Trial 2 25.2 0.44 0.64 1.1 Trial 3 30.4 0.44 0.65 1.08 Water + TYG*** Trial 1 32.9 0.42 0.62 1.01 Trial 2 30.6 0.41 0.61 0.99 Trial 3 33.5 0.41 0.61 1 *100 ml of 0.9% Sodium Chloride (Normal Saline) was used to dissolve 50 mg (1 vial) of Tygacil ® **100 ml of 0.9% Sodium Chloride (Normal Saline) was used to dissolve 100 mg (2 vials) of Tygacil ® ***100 ml of Sterile Water for Injection (USP) was used to dissolve 50 mg (1 vial) of Tygacil ® - Many variations of the present invention not illustrated herein will occur to those skilled in the art. The present invention is not limited to the embodiments illustrated and described herein, but encompasses all the subject matter within the scope of the appended claims.
Claims (10)
1. A method of treating a respiratory disorder comprising administering an antibiotic drug suitable for treating said disorder to a mammal in need thereof via a SWIRLER drug delivery system which produces a liquid aerosol composition of said antibiotic drug in which the particle size of at least about 90% of the antibiotic droplets in the aerosol is about 1-3 microns or less, wherein said antibiotic drug comprises ZOSYN, Piperacillin, Tazobactam, or TYGACIL.
2. The method of claim 1 , wherein the particle size of at least about 95% of the aerosol composition is 1-3 microns or less.
3. The method of claim 1 , wherein the particle size of at least about 90% of the antibiotic droplets in the aerosol is about 1.1 microns or less.
4. The method of claim 1 , wherein the particle size of at least about 95% of the antibiotic droplets in the aerosol is about 1.1 microns or less.
5. The method of claim 1 , wherein the aerosol composition comprises an antibiotic and a diluent.
6. The method of claim 5 , wherein the diluent comprises sterile water for Injection, 0.9% sodium chloride for injection, 5% dextrose for injection, 5% dextrose and 0.9% sodium chloride for injection, 5% dextrose in lactated Ringers for injection, 5% dextrose-0.45% sodium chloride-0.15% potassium chloride for injection, or lactated Ringers for injection.
7. The method of claim 1 , wherein the respiratory disorder is cystic fibrosis.
8. The method of any one of claims 1 , wherein the antibiotic can be administered alone or in combination with other antibiotics.
9. The method of claim 1 , wherein the particle size of at least about 90% of the antibiotic droplets in the aerosol is about 1.1 microns or less and the aerosol composition comprises an antibiotic and a diluent.
10. The method of claim 9 , wherein the respiratory disorder is cystic fibrosis.
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